Objective:To explore the clinical characteristics, diagnosis and treatment strategies, and prognosis of pulmonary embolism (PE) complicating childhood rheumatic diseases.Methods:A retrospective case series study was performed on the demographic data, laboratory indicators, imaging features, treatment regimens, and follow-up data of 8 children with rheumatic diseases complicated by PE who were admitted to the Department of Rheumatology and Immunology, Capital Center for Children′s Health, Capital Medical University from January 2014 to October 2023.Results:Among the 8 children, there were 4 boys and 4 girls, with an age of 12.0 (7.5, 13.0) years. Among the primary diseases, there were 3 cases of systemic lupus erythematosus, 2 cases of Beh?et′s disease, 2 cases of Takayasu arteritis, and 1 case of antiphospholipid syndrome. All children developed PE during the active phase of the primary disease. PE was detected at the onset of the primary disease in 3 cases, and the median time from the diagnosis of the primary disease to the development of PE was 10.0 (6.0, 25.0) months in the remaining 5 cases. Fever was present in all 8 children, 4 cases were accompanied by chest tightness, dyspnea, etc., and 2 cases only presented with fever. Laboratory examinations revealed the following results: erythrocyte sedimentation rate was 42.0 (17.0, 78.0) mm/1 h, high-sensitivity C-reactive protein was 12.7 (2.6, 78.7) mg/L, white blood cell count was 9.6 (7.2, 18.7)×10 9/L; D-dimer was 2.3 (0.9, 6.2) mg/L; and hemoglobin was (109±16) g/L.Imaging examinations revealed that 5 cases had involvement of the bilateral lower pulmonary arteries, 5 cases had peripheral embolism, and 3 cases had central PE. Complications included 3 cases of deep vein thrombosis, 2 cases of intracranial venous sinus thrombosis, and 1 case of mild pulmonary hypertension.In terms of treatment, 7 cases received anticoagulation with heparin followed by warfarin. Immunomodulation was mainly based on glucocorticoids combined with immunosuppressants, and 4 cases were combined with biological agents. The follow-up time of 4.17 (1.75, 7.17) years, the time for complete absorption of PE was 10.5 (6.0, 18.0) months; all 8 children had no target events, with no recurrence or chronic thromboembolic pulmonary hypertension, and the pulmonary artery remodeling was good. Conclusions:PE complicating childhood rheumatic diseases is closely related to the activity of the primary disease. The clinical manifestations are insidious, with fever as the main symptom. Imaging examination is the key to diagnosis.Early adoption of heparin followed by warfarin anticoagulation and glucocorticoids combined with immunosuppressants and (or) biological agents to control the primary disease can achieve a favorable prognosis.

Objective:To explore the clinical characteristics, diagnosis and treatment strategies, and prognosis of pulmonary embolism (PE) complicating childhood rheumatic diseases.Methods:A retrospective case series study was performed on the demographic data, laboratory indicators, imaging features, treatment regimens, and follow-up data of 8 children with rheumatic diseases complicated by PE who were admitted to the Department of Rheumatology and Immunology, Capital Center for Children′s Health, Capital Medical University from January 2014 to October 2023.Results:Among the 8 children, there were 4 boys and 4 girls, with an age of 12.0 (7.5, 13.0) years. Among the primary diseases, there were 3 cases of systemic lupus erythematosus, 2 cases of Beh?et′s disease, 2 cases of Takayasu arteritis, and 1 case of antiphospholipid syndrome. All children developed PE during the active phase of the primary disease. PE was detected at the onset of the primary disease in 3 cases, and the median time from the diagnosis of the primary disease to the development of PE was 10.0 (6.0, 25.0) months in the remaining 5 cases. Fever was present in all 8 children, 4 cases were accompanied by chest tightness, dyspnea, etc., and 2 cases only presented with fever. Laboratory examinations revealed the following results: erythrocyte sedimentation rate was 42.0 (17.0, 78.0) mm/1 h, high-sensitivity C-reactive protein was 12.7 (2.6, 78.7) mg/L, white blood cell count was 9.6 (7.2, 18.7)×10 9/L; D-dimer was 2.3 (0.9, 6.2) mg/L; and hemoglobin was (109±16) g/L.Imaging examinations revealed that 5 cases had involvement of the bilateral lower pulmonary arteries, 5 cases had peripheral embolism, and 3 cases had central PE. Complications included 3 cases of deep vein thrombosis, 2 cases of intracranial venous sinus thrombosis, and 1 case of mild pulmonary hypertension.In terms of treatment, 7 cases received anticoagulation with heparin followed by warfarin. Immunomodulation was mainly based on glucocorticoids combined with immunosuppressants, and 4 cases were combined with biological agents. The follow-up time of 4.17 (1.75, 7.17) years, the time for complete absorption of PE was 10.5 (6.0, 18.0) months; all 8 children had no target events, with no recurrence or chronic thromboembolic pulmonary hypertension, and the pulmonary artery remodeling was good. Conclusions:PE complicating childhood rheumatic diseases is closely related to the activity of the primary disease. The clinical manifestations are insidious, with fever as the main symptom. Imaging examination is the key to diagnosis.Early adoption of heparin followed by warfarin anticoagulation and glucocorticoids combined with immunosuppressants and (or) biological agents to control the primary disease can achieve a favorable prognosis.

ObjectiveTo evaluate the clinical efficacy of Huangqin Qingre Chubi capsules （HQC） in patients with rheumatoid arthritis （RA） and the syndrome of dampness-heat obstruction and investigate the mechanism by which HQC restore clinical and laboratory parameters in RA patients through regulation of the long non-coding RNA （LncRNA） endogenous Bornavirus-like nucleoprotein 3 pseudogene （EBLN3P）/miR-369-3p/nuclear factor I X（NFIX）-Janus kinase（JAK）/signal transducer and activator of transcription （STAT） signaling pathway，thereby providing new experimental evidence and potential therapeutic targets for the traditional Chinese medicine （TCM） treatment of RA. MethodsA randomized controlled trial design was adopted，with 100 RA patients meeting the criteria assigned into an observation group （n=50） and a control group （n=50）. In addition，50 healthy controls were enrolled. The control group received leflunomide plus meloxicam，while the observation group additionally received HQC. Efficacy was assessed after 4 weeks of treatment. Observation indicators including Western medicine indicators （DAS28，CPRI-RA，SF-36，VAS，PGA，PhGA，and SAS/SDS），TCM syndrome scores （TCMSS-RADHP，TCMSS-RASDP），and laboratory indicators （ESR，CRP，RF，anti-CCP antibody，VEGF，bFGF，MMP-2/9，p-JAK2/STAT3，and LncRNA EBLN3P/miR-369-3p/NFIX expression） were measured to comprehensively explore the therapeutic mechanism of HQC. ResultsThe study included 45 healthy controls （34 males and 11 females） and 87 RA patients （22 males and 65 females）. The median age，median disease duration，and median BMI of patients were 56 years old，10 years，and 21.51 kg·m^-2，respectively. Compared with healthy controls，the RA group exhibited a typical state of immune-inflammatory activation as manifested by elevated levels of ESR，anti-CCP antibodies，CRP，and RF （P<0.01），raised clinical symptom scores （DAS28，VAS，PGA，PhGA，CPRI-RA，and TCM symptoms） （P<0.05，P<0.01），and reduced SF-36 domain scores （P<0.01）. Molecular detection revealed abnormal expression of LncRNA EBLN3P and miR-369-3p，upregulated expression of key proteins in the JAK/STAT pathway （JAK2/p-JAK2 and STAT3/p-STAT3） and angiogenesis markers （VEGF，bFGF，and MMP-2/9），and downregulated expression of NFIX （P<0.05，P<0.01） in the RA group. Spearman correlation analysis further demonstrated associations of key molecules in the LncRNA EBLN3P/miR-369-3p/NFIX-JAK/STAT pathway with immune-inflammatory markers and clinical symptom scores （P<0.05，P<0.01）. Regarding treatment response，both groups showed reductions in ESR，anti-CCP，CRP，and RF levels compared with baseline （P<0.01） and restored scores of DAS28，CPRI-RA，VAS，PGA，PhGA，TCM symptoms，SAS，SDS，and all SF-36 domains （P<0.01）. The observation group outperformed the control group in restoring the scores of SAS，SDS，PGA，TCMSS-SDP，and SF-36 domains （PF，BP，GH，VT，and SF） （P<0.05）. Real-time PCR analysis revealed that post-treatment expression levels of LncRNA EBLN3P，miR-369-3p，NFIX，JAK2，p-JAK2，STAT3，p-STAT3，VEGF，bFGF，MMP-2，and MMP-9 were recovered compared with pre-treatment levels （P<0.01）. Notably，the observation group demonstrated superior regulatory effects on p-JAK2，STAT3，p-STAT3，and MMP-9 compared with the control group （P<0.05）. Apriori association rule analysis revealed that HQC treatment was significantly correlated with reduced TCMSS-RADHP，ESR，SF，DAS28，SAS，and SDS scores，as well as increased VT，GH，and RP scores （confidence >80%，support >50%）. Regarding safety，two patients in the observation group experienced mild gastrointestinal discomfort，and one patient in the control group developed a rash. All the symptoms resolved after symptomatic treatment. ConclusionHQC target and regulate the LncRNA EBLN3P/miR-369-3p/NFIX-JAK/STAT axis to inhibit angiogenesis and inflammatory responses，reduce immune inflammatory markers，alleviate clinical symptoms，and improve the quality of life in RA patients，exerting synergistic effects on symptoms and quality of life.

ObjectiveTo investigate the potential therapeutic effects of Dengzhan Shengmai capsules （DZSM） on myocardial fibrosis after myocardial infarction and decipher the underlying molecular mechanisms by virtue of network robustness algorithm. MethodsA rat model of myocardial infarction was established by ligating the left anterior descending coronary artery. Successfully modeled Sprague-Dawley rats were randomly allocated into a model group， an enalapril group（3.15 mg·kg^-1）， and high- and low-dose DZSM groups（226.8，113.4 mg·kg^-1）. In addition， a sham group was set up. After four consecutive weeks of intervention， the cardiac function was assessed via echocardiography， and myocardial collagen deposition was observed through Sirius red staining. The key regulatory pathways of DZSM were analyzed by the network robustness algorithm. Enzyme-linked immunosorbent assay （ELISA） and immunofluorescence assay were employed to validate the mechanisms. ResultsCompared with the sham group， the model group exhibited decreased left ventricular ejection fraction （LVEF%） and fractional shortening （FS%） （P<0.01） and increased myocardial collagen volume fraction （CVF%） （P<0.01）. Compared with the model group， high-dose DZSM and enalapril improved LVEF% and FS% （P<0.01）. Both high- and low-dose DZSM reduced the CVF% （P<0.05， P<0.05，）. Network analysis indicated that DZSM exerted its effects by regulating neutrophil infiltration and related inflammatory pathways. Experimental validation showed that DZSM significantly reduced the protein levels of nuclear factor （NF）-κB， Janus kinase 2 （JAK2）， and signal transduction activator and transducer 3 （STAT3） in the cardiac tissue， as well as the levels of chemokine （C-X-C motif） ligand 1 （CXCL1）， interleukin （IL）-1β， neutrophil elastase-DNA complex （NE-DNA）， and myeloperoxidase-DNA complex （MPO-DNA） in the plasma. ConclusionDZSM may ameliorate myocardial fibrosis by inhibiting neutrophil infiltration and extracellular trap formation and regulating the NF-κB/JAK2/STAT3 signaling pathway.

OBJECTIVE To investigate the current status of contamination with carbapenem-resistant gram-negative bacteria in environment of intensive care units(ICU)of tertiary hospitals in Shanghai and find out the potential contamination sources so as to provide bases for prevention and control of multidrug-resistant organisms infec-tions in the ICUs.METHODS The surroundings of the ICU patients detected with CRGNB and environmental ob-jects surfaces in public area were sampled by mSuperCARBA chromogenic media from Dec.2024 to Jan.2025,the strains were isolated,and the targeted strains were identified by matrix-assisted laser desorption/ionization time-of-flight(MALDI-TOF)mass spectrometer.RESULTS A total of 653 samples were collected in the survey,76 of which were positive for bacterial culture,60 were detected with CRGNB,and the isolation rate of CRGNB was 9.19％.The isolation rate of CRGNB was 53.40％in the water-source group,0.91％in the non-water-source group,and there was significant difference(x2=286.450,P＜0.001).The result of whole genome sequencing for 17 strains of CRKP showed that ST11 and ST15 were the two major types of multilocus typing(MT),respective-ly carrying 2-12 types of drug resistance genes.CONCLUSIONS The CRGNB strains are detected in some environ-mental sites of the ICUs of 15 tertiary hospitals in Shanghai,and the isolation rate of CRKP is highest among them.The colonization rate of CRGNB is relatively low on the highly frequent-contact object surfaces of the ICUs,however,sink drain holes poses a risk of hospital-acquired CRGNB infections transmissions.Additionally,the ba-sins and towels of the CRGNB patients are hard to be thoroughly cleaned,disinfected and dried,resulting in a high contamination rate.

Objective To investigate the efficacy and safety of self-help inflatable balloon in the treatment of refractory benign upper digestive tract stricture.Methods From November 2022 to February 2024,10 patients with refractory benign upper digestive tract stricture underwent self-help inflatable balloon were retrospectively analyzed.Preoperative treatment,intraoperative and postoperative complications,dysphagia score before and after surgery,wearing time of external self-help inflatable balloon,and the clinical efficacy were evaluated.Results All the 10 patients received self-help inflatable balloon treatment.No complications such as bleeding and perforation occurred in all patients during the wearing of the balloon.The placement time of the balloon was 60～180 d,and the average wearing time was 104.9 d.Before surgery,nine cases had a stricture segment length less than 2 cm,and one case had a stricture segment length of 6 cm.The dysphagia score before surgery was(3.60±0.52),and the dysphagia score after removal of the self-help inflatable balloon was(0.60±0.52),and there was statistical significance in preoperative and postoperative comparison(P＜0.05).The dysphagia score 3 months after removal of the external self-help inflatable balloon was(0.70±0.48),there was no significant difference in dysphagia score between the day after surgery and 3 months after surgery(P＞0.05).The diameter of the stricture before and after operation was(5.09±2.02)mm and(10.35±0.73)mm respectively,and the difference was statistically significant(P＜0.05).Sore throat,wing of nose pain and balloon displacement were the most common adverse events,with 30.0％(3/10),50.0％(5/10)and 70.0％(7/10),respectively.Conclusion It is safe,effective and feasible to treat refractory benign upper digestive tract stricture with self-help inflatable balloon in vitro.It is worthy for clinical application.

Purpose To investigate the value of intratumoral and different ranges of peritumoral radiomics features of the primary lesion of breast cancer based on ultrasound images in predicting axillary lymph node metastasis(ALNM),and to explore the best peritumoral range.Materials and Methods A total of 312 cases confirmed by pathology in breast cancer patients with preoperative ultrasound images from June 2022 to February 2024 in Binzhou Medical University Hospital were retrospectively enrolled,and were randomly divided into training set and testing set according to the 7∶3 proportion.The tumor border of the ultrasound images was manually delineated as the intratumoral region of interest,and the peritumoral region of interest was obtained by conformal automatically extended different range(1,2,3,4 and 5 mm).The radiomics features were screened.Based on the selected optimal radiomics features,random forest classifier was used to construct three types of radiomics models(intratumoral model,5 peritumoral models,and 5 intratumoral+peritumoral models).The performance and clinical practicability of the models was assessed the area under the curve(AUC)and decision curve analysis.Results The AUCs of the intratumoral+peritumoral radiomics models for predicting ALNM in the training set and test set were 0.807-0.873,0.728-0.780,respectively,which were superior to those of the single intratumoral radiomics models(0.822,0.758)and peritumoral radiomics models(0.722-0.768,0.650-0.710).The intratumoral+peritumoral 3 mm radiomics model showed the best predictive performance,with AUC of 0.873 in the training set and 0.780 in the test set,respectively,and the decision curve showed that the model had a good clinical net benefit.Conclusion The combined intratumoral and peritumoral radiomics features of the primary lesion of breast cancer based on ultrasound images can effectively predict ALNM,and 3 mm peritumoral may be the best peritumoral range for predicting ALNM.

OBJECTIVE To investigate the current status of contamination with carbapenem-resistant gram-negative bacteria in environment of intensive care units(ICU)of tertiary hospitals in Shanghai and find out the potential contamination sources so as to provide bases for prevention and control of multidrug-resistant organisms infec-tions in the ICUs.METHODS The surroundings of the ICU patients detected with CRGNB and environmental ob-jects surfaces in public area were sampled by mSuperCARBA chromogenic media from Dec.2024 to Jan.2025,the strains were isolated,and the targeted strains were identified by matrix-assisted laser desorption/ionization time-of-flight(MALDI-TOF)mass spectrometer.RESULTS A total of 653 samples were collected in the survey,76 of which were positive for bacterial culture,60 were detected with CRGNB,and the isolation rate of CRGNB was 9.19％.The isolation rate of CRGNB was 53.40％in the water-source group,0.91％in the non-water-source group,and there was significant difference(x2=286.450,P＜0.001).The result of whole genome sequencing for 17 strains of CRKP showed that ST11 and ST15 were the two major types of multilocus typing(MT),respective-ly carrying 2-12 types of drug resistance genes.CONCLUSIONS The CRGNB strains are detected in some environ-mental sites of the ICUs of 15 tertiary hospitals in Shanghai,and the isolation rate of CRKP is highest among them.The colonization rate of CRGNB is relatively low on the highly frequent-contact object surfaces of the ICUs,however,sink drain holes poses a risk of hospital-acquired CRGNB infections transmissions.Additionally,the ba-sins and towels of the CRGNB patients are hard to be thoroughly cleaned,disinfected and dried,resulting in a high contamination rate.

Objective:To explore the effects of essential tremor(ET)on the mitochondrial morphology of GABAer-gic and glutamatergic neurons in the inferior olive(IO).Methods:The ET mouse model was established via intraper-itoneal injection of harmaline.Twelve 8-week-old male C57BL/6J mice were randomly divided into saline control group and harmaline treatment group(HA).Behavioral tests,including open field test,rotarod test,balance beam test,and tremor scoring,were conducted to assess the behavior of mice.Using genetic engineering technology and the CRISPR/Cas9 system,we designed and generated 6 male GAD2-Mito-GFP mice and 6 male VGLUT2-Mito-GFP mice,all being 8-week-old.The mice of each transgenic line were randomly divided into Control and HA group.Immunofluorescence staining was used to analyze the expression of c-FOS positive cells in the IO of both the Control and HA groups,and to classify different types of neurons.Mitochondrial network analysis(MiNA)was performed to quantitatively analyze the area,mean aspect ratio,branch length,and other of mitochondria in different types of neurons in the IO under ET con-ditions.Results:Compared to the Control group,the HA group exhibited motor abnormalities and significant tremors.Immunofluorescence results showed a significant increase in the number of c-FOS positive cells in the IO,primarily in GABAergic neurons.MiNA results revealed that the mitochondria of GABAergic neurons showed increased area,branch length diameter,demonstrating irregular morphology.Conclusion:ET induces activation of GABAergic neurons in the IO and leads to more prominent mitochondrial morphological changes.This provides a new perspective for further inves-tigation of the pathogenesis of essential tremor and its relationship with mitochondrial.

Objective:Dynamic navigation approaches are widely employed in the context of implant placement surgery.Implant surgery can be divided into immediate and delayed surgery according to the time of implantation.This retrospective study was developed to compare the accuracy of dynamic naviga-tion system for immediate and delayed implantations.Methods:In the study,medical records from all patients that had undergone implant surgery between August 2019 and June 2021 in the First Clinical Di-vision of the Peking University School and Hospital of Stomatology were retrospectively reviewed.There were 97 patients[53 males and 44 females,average age(47.14±11.99)years]and 97 implants(de-layed group:51;immediate group:46)that met with study inclusion criteria and were included.Implant placement accuracy was measured by the superposition of the planned implant position in the preoperative cone beam computed tomography(CBCT)image and the actual implant position in the postoperative CBCT image.The 3-dimensional(3D)entry deviation(3D deviation in the coronal aspect of the alveolar ridge),3D apex deviation(3D deviation in the apical area of the implant)and angular deviation were analyzed as the main observation index when comparing these two groups.The 2-dimensional(2D)horizontal deviation of the entry point and apex point,and the deviation of entry point depth and apex point depth were the secondary observation index.Results:The overall implant restoration survival rate was 100％,and no mechanical or biological complications were reported.The implantation success rate was 100％.The 3D entry deviation,3D apex deviation and angular deviation of all analyzed implants were(1.146±0.458)mm,(1.276±0.526)mm,3.022°±1.566°,respectively;while in the de-layed group these respective values were(1.157±0.478)mm,(1.285±0.481)mm and 2.936°±1.470° as compared with(1.134±0.440)mm,(1.265±0.780)mm,3.117°±1.677° in the immediate group.No significant differences(P=0.809,P=0.850,P=0.575)in accuracy were observed when comparing these two groups.Conclusion:Dynamic computer-assisted implant surgery system promotes accurate implantation,and both the immediate and delayed implantations exhibit similar levels of accura-cy under dynamic navigation system that meets the clinical demands.Dynamic navigation system is feasi-ble for immediate implantation.